Patient Specific Instruments. Surgical Technique

Transcription

1 Patient Specific Instruments Surgical Technique

2

3 Patient Specific Instruments Surgical Technique INTRO Introduction General Considerations Zimmer Patient Specific Instruments (PSI) are not designed for use with the Zimmer MIS Quad-Sparing Total Knee Procedure. Zimmer PSI should be used in conjunction with a femur first technique. Verify stability and fixation of all pins. When securing the conventional cutting guides, avoid the use of spring pins as these may cause stress / unwanted shift on the cutting guide. INTRO.1

4 TOC Patient Specific Instruments Surgical Technique Persona The Personalized Knee System Patient Specific Instruments Surgical Technique Table of Contents Femoral Technique 1 Tibial Technique 3 TOC.1

5 1A Femoral Technique 1 Femoral Technique Position Femoral Pin Guide Do not remove osteophytes from the femur. Position the Pin Guide on the distal femur (Fig. 1). Pin Guide will be captured by the anterior ridge of the femur. The epicondylar axis and A/P axis reference lines on the Pin Guide can be used to assess alignment. Apply posterior pressure to the Pin Guide and verify secure fit. Fig. 1 Drill and Pin the Anterior Pin Holes Drill and pin the anterior medial and lateral pin holes of the Pin Guide using the Universal Disposable Drill ( ) (Fig. 2). Fig. 2 Drill Distal Pin Holes Drill the distal pin holes of the Pin Guide (do not place pins) (Fig. 3). TECHNIQUE TIP 1.A When drilling the distal pin holes, ensure the holes are deep enough for visibility after the distal cut occurs. Fig. 3 Instruments PSI Femoral Pin Guide / 29/ 33/ 36 Universal Pin and Drill Kit

6 1 Femoral Technique Place Distal Cut Guide and Cut Femur Remove the Pin Guide by sliding it off the pins, leaving the anterior pins in the bone. Secure the Persona 0 Captured / Uncaptured Cutting Head ( ). Verify the distal resection on the medial and lateral side with a resection guide. Check alignment if desired, and make the cut (Fig. 4). TECHNIQUE TIP 1.B When performing the cuts, excessive force (considering the pressure being applied to the guide) on the medial or lateral side of the cut guide could influence the amount of varus/valgus in the cut. Fig. 4 TECHNIQUE TIP 1.C If more fixation is required, insert a 3.2mm trocar tipped pin in the oblique hole on the cutting head. Remove Distal Cut Guide Locate the drilled pin holes. Remove the anterior pins (Fig. 5). TECHNIQUE TIP 1.D Fig. 5 In the event the drilled distal holes are covered up following the distal cut, clean the area. Alternatively, prior to removing the anterior pins, place the Pin Guide back over the anterior pins and locate the distal pins through the distal Pin Guide holes. Place the Persona 4-in-1 Femoral Cut Guide Secure the Persona 4-in-1 Cut Guide ( _74 for Anterior Referencing or _74 for Posterior Referencing) and insert 3.2mm Trocar-tipped pins through the oblique holes of the cut guide. Verify resections using a resection guide. Finish the femur following the instructions from the Zimmer Persona The Personalized Knee Surgical Technique (Fig. 6). Fig. 6 Instruments 2 0 Captured / Uncaptured Cutting Head Persona 4-in-1 Cut Guide _74 OR _74 Resection Guide mm x 75mm Trocar Tipped Drill Pin (2.5mm nex) Pin / Screw Inserter

7 Tibial Technique 2 Tibial Technique Position Tibial Pin Guide Remove the meniscus. Do not remove osteophytes from the tibia. Remove any soft tissues that may prevent proper placement of the Pin Guide. Position the Pin Guide on the tibia (Fig. 7). Ensure the posterior medial hook goes over the posterior ridge of the tibia. The mechanical axis and proximal resection lines may be used to assess the alignment.. Fig. 7 Note: The tibia alignment may be verified by inserting the Tibia Alignment Adapter and Alignment Rod into the Tibia Pin Guide alignment holes (Fig. 8a & 8b). Fig. 8a Fig. 8b Drill and Pin Anterior Lateral Pin Hole Drill and pin the lateral hole of the Pin Guide (Fig. 9). Fig. 9 Drill Anterior Medial Hole Drill the medial hole of Pin Guide (do not place pin) (Fig. 10). Fig. 10 Instruments PSI Tibia Pin Guide / 29/ 33/ 36 Alignment Adapter Alignment Rod with Coupler Universal Pin and Drill Kit

8 2 Tibial Technique Establish Tibia Rotation (Drill Proximal Holes) Tibia rotation may be established through the Pin Guide per surgeon discretion. Drill the proximal medial and lateral holes of the Pin guide (do not place pins). Drill deep enough to ensure visibility after the proximal resection (Fig. 11). Fig. 11 Remove Tibial Pin Guide Remove the Pin Guide by lifting the medial hook off the posterior ridge and sliding off the anterior lateral pin (Fig. 12). Do not pry the Pin Guide from the tibia as this could shift the pins. (It may be necessary to remove the previously placed pin from the anterior lateral hole.) Fig. 12 Place Pins in Anterior Holes Ensure both pins are placed in the drilled anterior holes (Fig. 13). Fig. 13 Instruments 4 PSI Tibia Pin Guide / 29/ 33/ 36 Universal Pin and Drill Kit

9 Tibial Technique 2 Secure Cut Guide and Cut Tibia Secure the Persona Tibial Cut Guide. If more fixation is required, insert a 3.2mm Trocar-tipped pin in the oblique hole on the cutting head. Verify resections using the resection guide. Make tibial cut (Fig. 14). Use the appropriate right or left tibia cut guide. 3 Persona Left Cut Guide Persona Left Cut Guide Persona Right Cut Guide Persona Right Cut Guide Fig. 14 Insert the Alignment Adapter into the Tibial Cut Guide, insert the Alignment Rod and check alignment (Fig. 15). Alignment Adapter Alignment Rod TECHNIQUE TIP 2.A When fixating the Cut Guide, excessive force from screws can alter the planned location and could influence the amount of varus/valgus in the cut. TECHNIQUE TIP 2.B When performing the cuts, excessive force (considering the pressure from leaning on the guide) on the medial or lateral side of the cut guide could influence the amount of varus/valgus in the cut. Fig. 15 Instruments Persona Tibia Cut Guide / /07 Alignment Adapter Alignment Rod with Coupler mm x 75mm Trocar Tipped Drill Pin (2.5mm nex) Pin / Screw Inserter

10 2 Tibial Technique Position Tibial Sizing Plate Place tibial sizing plate on the cut surface. Align the first hole on the tibia plate to the hole on the tibia. Place the pin. Rotate the tibia plate until the second pin hole aligns with the remaining pre-drilled holes (Fig. 16). TECHNIQUE TIP 2.C In the event the drilled proximal holes are covered up following the proximal cut, clean the area. Alternatively, prior to removing the anterior pins, place the Pin Guide back over the anterior pins and locate the proximal holes through the tibial Pin Guide. Fig. 16 Follow Persona The Personalized Knee System Surgical Technique Following the positioning of the tibial component, proceed with the surgery as suggested in the Zimmer Persona The Personalized Knee System Surgical Technique. Instruments 6 Persona Cemented Tibial Sizing Plate /61/ 64/67/71/75/79/ 83/88-01_02 Persona Tibial Sizing Plate Handle

11 1

12 Note: Materialise and the Materialise logo are trademarks of Materialise NV This documentation is intended exclusively for physicians and is not intended for laypersons. Information on the products and procedures contained in this document is of a general nature and does not represent and does not constitute medical advice or recommendations. Because this information does not purport to constitute any diagnostic or therapeutic statement with regard to any individual medical case, each patient must be examined and advised individually, and this document does not replace the need for such examination and/or advice in whole or in part. Please refer to the package inserts for important product information, including, but not limited to, contraindications, warnings, precautions, and adverse effects. Contact your Zimmer representative or visit us at The CE mark is valid only if it is also printed on the product label Rev K Zimmer, Inc.